Clinical feasibility of transfer to combined therapy with peritoneal dialysis and hemodialysis for patients on peritoneal dialysis: A prospective multicenter study in Japan.

Introduction: Although combined therapy with peritoneal dialysis (PD) and hemodialysis (HD) is widespread in Japan, its clinical utility has been reported only in retrospective or before-and-after test lacking a control group.

Methods: We conducted a prospective, multicenter, observational cohort study of 176 incident PD patients and compared patient survival and changes in clinical parameters between patients on different dialysis modalities.

Results: During a median follow-up of 41 months, 47 patients transferred to combined therapy and 35 patients transferred directly to HD.

Pleiotropic effect of erythropoiesis-stimulating agents on circulating endothelial progenitor cells in dialysis patients.

Background: Recent studies have suggested that erythropoiesis-stimulating agents (ESAs) may accelerate not only angiogenesis but also vasculogenesis, beyond erythropoiesis.

Methods: We conducted a 12-week prospective study in 51 dialysis patients; 13 were treated with recombinant human erythropoietin (EPO, 5290.4 ± 586.

Modulation of circulating endothelial progenitor cells by erythropoiesis-stimulating agents in patients with chronic kidney disease stage G5 and 5D .

Aims: Circulating endothelial progenitor cells (EPCs) play a pivotal role in vasculogenesis and promote angiogenesis by secreting growth factors. Recent studies have suggested that erythropoietin (EPO) may accelerate not only angiogenesis but also vasculogenesis, beyond erythropoiesis. The aim of this study was to investigate whether two erythropoiesis-stimulating agents (ESAs) modulate vascular-related factors and EPC mobilization in patients with chronic kidney disease stage G5 and dialysis (CKD G5 and 5D).

Combined therapy with peritoneal dialysis and hemodialysis: a multicenter retrospective observational cohort study in Japan.

Background/aims: Combining peritoneal dialysis (PD) and hemodialysis (HD) has been common treatment option in Japan.

Methods: In this retrospective, multicenter, observational study, the clinical characteristics and outcomes of 104 patients (57 ± 11 years, males 72%) who had switched from PD alone to combined therapy with PD and HD were studied. Clinical parameters were measured at baseline and after 3 months of combined therapy.

The Prevalence of the Risk Factors for Atherosclerosis among Type 2 Diabetic Patients Is Greater in the Progressive Stages of Chronic Kidney Disease.

Background/aims: The prevalence of the risk factors for atherosclerosis, other than diabetes mellitus, among type 2 diabetic patients with different stages of chronic kidney disease (CKD) determined by glomerular filtration rate (GFR) was investigated.

Methods: The prevalence of ten risk factors (age ≥65 years, history of smoking, male gender, obesity, albuminuria, hypertension, hypercholesterolemia, hypo-HDL-cholesterolemia, hyperuricemia and anemia) was determined in 2,107 Japanese type 2 diabetic patients with different stages of CKD (six stages according to GFR).

Results: The risk factors for age ≥65 years and male gender were found in 49 and 62% of the study subjects, respectively.

Vildagliptin is Effective for Glycemic Control in Diabetic Patients Undergoing either Hemodialysis or Peritoneal Dialysis.

Introduction: Vildagliptin can be used in patients with type 2 diabetes mellitus and renal impairment. However, there have been few reports investigating the clinical effectiveness of vildagliptin in diabetic patients undergoing hemodialysis. No previous studies have evaluated the use of vildagliptin in patients undergoing peritoneal dialysis.

Randomized controlled open-label trial of vitamin E-bonded polysulfone dialyzer and erythropoiesis-stimulating agent response.

Background And Objectives: A 1-year multicenter prospective randomized controlled study was conducted on the effects of vitamin E-bonded polysulfone dialyzers on erythropoiesis-stimulating agent response in hemodialysis patients.

Design, Setting, Participants, & Measurements: Major inclusion criteria were use of high-flux polysulfone dialyzers with 50-70 ml/min β2-microglobulin clearance over 3 months, transferrin saturation over 20%, same erythropoiesis-stimulating agent for over 3 months, and hemoglobin at 10-12 g/dl. Hemodialysis patients were placed in four interventional groups: two hemoglobin ranges (10.

Selection guidelines for high-performance membrane.

The fundamental concept for the selection of high-performance membrane is based on solute removal capability and biocompatibility. From this principle, the selection guidelines for high-performance membrane are recommended as follows: (1) The currently available products do not provide coverage of the necessary 'balance between solute removal and biocompatibility' in a single dialyzer for all the dialysis patients. Therefore, it is advisable to choose a high-performance membrane taking into consideration the balance between the solute removal capacity necessary for the patient and the severity of complications that is considered a surrogate marker for biocompatibility.

Evaluation of taurine as an osmotic agent for peritoneal dialysis solution.

Objective: The development of a glucose-free peritoneal dialysis (PD) solution is important because glucose has been associated with functional and morphological damage to the peritoneal membrane. The ultrafiltration (UF) and biocompatibility of new PD solutions containing taurine (PD-taurine) instead of glucose as an osmolite were tested in a rat PD model.

Methods: To determine the solution's UF ability, different concentrations of taurine in PD solutions were compared to glucose-based PD solutions (PD-glucose) by giving single intraperitoneal injections for 2, 4, and 6 hours.

Losartan elevates the serum high-molecular weight-adiponectin isoform and concurrently improves insulin sensitivity in patients with impaired glucose metabolism.

Adiponectin is an adipocyte hormone that ameliorates insulin resistance and prevents diabetes. Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are at a high risk of developing diabetes and cardiovascular diseases. Since treatment with angiotensin II receptor blockers retards the development of diabetes, the effects of losartan on serum adiponectin levels were examined with regard to insulin sensitivity in pre-diabetic patients.

[Clinicopathological analysis of malignant nephrosclerosis].

Background: Although pathological changes in the vascular lesions of malignant nephrosclerosis have been quantified, little is understood about interstitial changes. We quantified pathological changes such as glomerular damage (glomerular sclerosis and collapse), vascular patency and interstitial fibrosis to determine statistical correlations with clinical data.

Methods: We examined 25 patients who were diagnosed with malignant hypertension and investigated correlations among age, urinary protein, SUN, 1/Cre, systolic BP and diastolic BP (from medical charts), interstitial fibrosis, glomerular damage, acute tubular damage (semiquantified by scoring) and arterial and arteriolar patency (from renal biopsies).

[Histological investigation of renal pathological changes in MPO-ANCA-related nephritis using repeat renal biopsies].

We compared the histological changes before and after treatment in 14 cases of myeloperoxidase antineutrophil cytoplasmic autoantibodies (MPO-ANCA) related nephritis in whom we were able to perform two renal biopsies. The results show that the clinical findings and acute glomerular and tubulointerstitial injuries decreased, while chronic glomerular injuries increased. No changes were seen in minor glomerular abnormalities(MGAs) or chronic tubulointerstitial injuries between the first and second biopsies.

Urinary excretion of creatol, an in vivo biomarker of hydroxyl radical, in patients with chronic renal failure.

Creatol (CTL) is a hydroxyl radical adduct of creatinine (Cr). The serum methylguanidine (MG) level and the MG/Cr molar ratio are reported to be biomarkers for oxidative stress. The aim of this study was to examine whether urinary excretion of CTL, another oxidative stress-related marker, is increased in patients with chronic renal failure (CRF).

Prediction method for decreases in blood pressure during hemocatharsis therapy by arteriolar blood flow measurement.

In clinical practice, the prediction of changes in blood pressure during hemocatharsis therapy depends on invasive monitoring, the physician's experience, or blood pressure measurement when patients ask for it. It is extremely difficult to predict blood pressure variation in patients under general anesthesia or with disturbance of consciousness. Therefore, the prediction of blood pressure variation during hemocatharsis therapy is an important issue.

Analysis of hemodynamics during blood purification therapy using a newly developed noninvasive continuous monitoring method.

Advancement in blood purification therapy extends not only to consoles and dialyzers, but also to patient management during blood purification therapy. However, no monitor has been devised for hemodynamics during blood purification therapy that is carried out continuously and non-invasively. By studying the laser Doppler flowmeter (LDF), we have developed a probe that can continuously measure changes in blood flow in tissues of the head and lower extremities during blood purification therapy.

Biocompatibility of peritoneal dialysis fluid and influence of compositions on peritoneal fibrosis.

Conventional peritoneal dialysis fluid (PDF) is a bioincompatible solution because of several components. These unphysiological compositions might contribute to the development of peritoneal fibrosis. In the present overview we summarize the influence of each composition of PDF (acidic pH, high concentration of glucose and glucose degradation products; advanced glycation end-products and lactate) on the peritoneal fibrotic changes in long peritoneal dialysis (PD) patients.